Wednesday, August 02, 2006

Birth plan

As I mentioned, since reading "Natural birth the bradley way", I've also read a couple of other books on the topic of delivery, and more specifically, the things that your doctors don't necessarily tell you ("The thinking woman's guide to a better birth", and "The silent knife" about C-sections and VBAC. I wouldn't say that reading these has scared me, but they have definitely raised some questions in my mind about standard obstetrical practice that have made me realize that M and I are going to need to be more proactive in our management of Phred's delivery that I would have anticipated had I not read these books, and learned about the possible negative effects of standard care. So, here's what I'm thinking (assuming, of course, that I don't have to have a c-section because Phred is still breech).

Please note that these are my opinions, based on what I've read. I'm not criticizing anyone else's choices!

1. Eating and drinking during active labor. Strongly discouraged by the hospital, in case you need general anesthesia for an emergency c-section. Problem is that it can cause dehydration (leading to the need for IV fluids, see #2), and lack of energy for the second stage of labor. Which can lead to an extended pushing phase, and c-section for "failure to progress". They claim that if you are put under with food in your stomach, you might throw up and aspirate the contents of your stomach = bad. But, if you haven't been eating or drinking, you throw up gastric juices, which to me seems a lot worse. At my hospital, the rate of c-sections is 30%, the rate of general anesthesia is 5%, which means that absolute max, 1.5% of people are having GA with a c-section. And as the 30% rate includes planned c-sections as well, it's actually a lot less than that. AND, if someone's been in a car accident or the like, they almost certainly don't have an empty stomach. So I think that the prohibition on eating / drinking is bogus, and don't plan to follow it. (Which I will let them know if I do end up needing GA).

2. No IV fluids for hydration. The rate of IV's is quite astonishing - 94%! Are that many of us really dehydrated? When I was in for my contractions they stuck an IV in me 2/3 times - the first I managed to convince them that I really was not having the contractions because of dehydration (I had had over 100oz of fluid during the day). The second time they wanted to try it anyway, despite my saying the same thing. And it made no difference to the contractions whatsoever. And then the third was when I was having the magnesium, which needed to go in through an IV. But, our hormones are fairly delicately balanced, and getting more fluid than needed can screw with that balance. Perhaps leading to a slowdown in labor, so pitocin to help... blah blah blah. Slippery slope.

3. No induction. If Phred isn't ready to come out yet, I don't see any reason to force it. Plus, it seems like very few people who are induced end up with a normal, natural labor. I'd rather be pregnant for a few more days.

4. No breaking of waters to speed up labor. The amniotic sac can A) help with opennig the cervix more gently, B) cushion the baby's head, and C) equalize the pressure the baby feels with contractions - less fetal distress.

5. Minimal external fetal monitoring. The standard is to throw those suckers on you as soon as you arrive in the hospital, and keep them on the entire time. However, they definitely seem to lead to a higher c-section rate, because as soon as any kind of issue is seen, the doctors feel like they have to fix it right away. There has been a fair amount of research into this topic, and almost every article says that "intermittent auscultation" is just as effective at catching real problems as the continuous monitoring is, while lessening the c-section rate.

6. No time limits on labor (within reason). First, there seems to be a "you have to deliver within 24 hours of your water breaking" paradigm in place these days. Because of threat of infection. But studies have shown that there is no increased risk of infection just because of broken waters, especially if no internal exams are performed. So I'm thinking that if this happens and I don't start having contractions right away, I'm not even going to bother calling the hospital at that point. I also do not want a c-section just because I've been in phase 1 for X number of hours, or phase 2 for 2 hours. The time limits used seem to be actually quite fast, so I'm not going to let them pressure me into having a c-section just because of those.

7. No scheduled c-section, even if Phred does seem to want to stay breech. I figure the longer he/she is in there, the more chance there is of turning over, however remote it may be.

I think that about covers it!


One Mother's Journey said...

I hope you get the birth experience you want. It may be difficult to get your hospital staff to go along with all of that but stick to your guns if it's what you really want. It's your body and your baby.

Katie (WannaBeMom) said...

You should totally read the Ina May Gaskin book we just finished... It's a bit (well, a lot) granola-ish, but quite a few of things you referenced here were talked about in her book. I loved it and felt totally empowered by it. I can't remember the name, but if you're interested, I'll go find it!

pixi said...

Wow, I should be so informed. I appreciate that you're sharing what you're learning with us!

elle said...

Absolutely, I second the Ina May Gaskin book - a must read. And I would also advise against saying "no this procedure or that procedure" I did have a natural birth in a birthing center with with a midwife, nurse, doula and husband and I did need an IV as I was vomiting every few hours. I did have to have my water broken as my labor was stalled at 5 cm for five hours. Things happen that are completely out of your control. It's best to be really flexible and open minded. That said, I hope you have a wonderful natural birth.

Nico said...

Elle, you have a really good point. I'm definitely willing to be flexible, and totally understand that every situation is different and needs to be evaluated as such. I guess what I don't want is just to go in and automatically have these things done because that's what they do.

MsPrufrock said...

This sounds like really simplistic advice, but make sure you question EVERYTHING they try to do which goes against your birth plan. In my antenatal class we discussed the medical community's inherent need to administer medication, something to be wary of.

The situation is so much different here in the UK. In my ONE FRIGGIN WEEK in the maternity ward I saw one woman with an IV. Additionally, you rarely hear of much intervention, and if there is, it seems to be genuinely required rather than debatable.

Just be flexible, as it seems you will be anyway. I know how disappointed in themselves some women are when it doesn't all go to plan.

S. said...

Sounds like you've done your research.
The only thing I'd like to mention is regarding the eating. You may want to keep in mind that whatever you eat may come back up! I didn't feel nauseous until after delivery and I got sick 5 times. I was grateful that I didn't have actual food in my stomach. It would've made it that much more gross and harder to throw up because there would've been substance.
Just my .02 :)

Good to hear that everything is going well for you now.

Leigh said...

I am so grateful to have the advantage of learning from you! Other than the Bradley book and the Ina May Gaskin katie mentioned are there any other books you'd recommend? Good luck with things as they progress. I'm still sending toes-up thoughts Phred's way!

Leigh said...

Sorry--pregnancy brain. I just went back and reread your post and saw that you actually *did* recommend a few other titles! Sorry!

Hoping said...

I hope your birth experience is all that you hope for, hang in there not too long now!

Thalia said...

Sounds like you've done some v helpful research. I hope it stands you in good stead.

Alexa said...

I know very little about birth plans, but I did just read a really interesting study regarding laboring with social support. I wish I could find a link...anyway, they were trying to measure something else related to women who had doulas and women who did not, and found quite by accident that women who had more social support during labor were less likely to become "stalled" or require intervention. It has been speculated that this is actually an evolutionary adaptation due to the dangers of human birth (large fetal head size, etc.) and the adviability of having someone around to help. Women who had less social support during labor had higher stress-related cortisol levels, which slowed contractions, or somesuch.
Possibly beside the point, but interesting, don't you think?

soralis said...

Good luck, I hope everything goes as planned.

Take care

mermaidgrrrl said...

I work in peri-operative services and have nursed in most settings (including trauma with your mentioned car accident patients) and the risk of aspiration on induction is really not very high. We have a special way of putting people off to sleep when we think they're not fasted so that they can't aspirate. You're more likely to aspirate when they are taking the breathing tube out rather than putting it in, which a good doctor should be able to manage easily. From what I have read a huge number of women vomit when entering 2nd stage labour anyway, emptying their stomach themselves.

Kath said...

Dear Nico, I'm just checking in. I'm so glad you're doing so well, and hope that Phred turns around while he's still got a little room to wiggle.

It sounds as if you have done very careful research, and I hope that the birth goes just how you want it to. I'm so thrilled that you're already so far along!

Erin said...

Nico, make sure you talk to your practice about as much of it ahead of time as possible. Sometimes your OB can get around "standard practices" at the hospital--i.e. it's "standard practice" around here to make moms have IVs, but if your dr OK's a heplock, you don't have to be hooked up to fluids. Also, ask what your OB thinks about time limits on different stages. He or she might not have the same limitations as other practices or might be more conservative--either way, it's good to know ahead of time.

And (more assvice from a Bradley teacher) always make sure your first question when they want to do anything to you that doesn't match your birth plan is "Are Nico and Phred OK?" If you're both healthy and tolerating labor well, then you've got more leverage to say "Thanks, but I think we'll stick with what we're doing."

Love #7--even if Phred stays persistently breech (and you're right, babies can turn very, very late in pregnancy) and you end up with a c-sec, you'll know that he/she was ready to be born because you let yourself go into labor.

Good luck with all of it!

Fitgrl said...

Great info Nico - thanks! A lot to think about. I agree that it is so good that you have a plan and know what you want going in. At the end of the day you have to consent to what they are doing and you will do the right things for you & Phred.


sexy said...